EMR-Documented Contraception for Patients Prescribed Medications With Adverse Perinatal Outcomes

This cross-sectional study examines the rates of method of contraception documentation in the electronic medical record (EMR) for patients receiving 1 of 3 drugs known to be associated with adverse perinatal outcomes.


Introduction
Unintended pregnancy is a national health concern accounting for over 45% of pregnancies in the United States. 1 Many women in their reproductive years may receive treatment with medications associated with adverse perinatal outcomes in the absence of method of contraception documentation (MCD) in the electronic medical record (EMR). 2 Such medication exposures occur during organogenesis, and treatment options and/or interventions are subject to availability that is influenced by each state's political landscape. 3Modifications to the EMR could reduce risk and enhance clinician engagement.Previous research has shown that rates of MCD and counseling for women taking teratogenic medications increase significantly after educating clinicians about how to properly document this information in the EMR. 4 Hard stops in the EMR have proved to be an effective tool in improving patient process outcomes. 5This study examined EMR-documented MCD for women seen in outpatient clinics, focusing on 2 known teratogens (lithium and valproate) and a widely prescribed medication associated with adverse perinatal outcomes (gabapentin).

Methods
The University of Wisconsin-Madison Minimal Risk Research institutional review board classified this study as exempt because secondary research was used; no consent was required.This crosssectional study followed the STROBE reporting guideline.Using SlicerDicer within EpicCare Ambulatory, we examined the MCD for individuals who self-identified as female in the EMR, were between 12 and 50 years of age, and were seen by a University of Wisconsin Health clinician in an outpatient clinic between August 1, 2019, and August 1, 2022.SlicerDicer queries access anonymous Abbreviations: MCD, method of contraception documented; RR, relative risk.
a Women not taking any of the 3 medications were the reference group for the RR analyses.

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Discussion
Despite the well-documented risks, 6 women are prescribed valproate even though they are significantly less likely to have an MCD compared with women prescribed either lithium or gabapentin.It is reassuring that women prescribed any of these medications were significantly more likely to have an MCD compared with the group not prescribed a medication; this finding was consistent across all age groups.A limitation is that SlicerDicer does not have access to prescriptions obtained outside the University of Wisconsin Health system unless patients report those prescriptions.The reproductive safety for medications may not be well delineated when the medication is first approved for use and may change with postmarketing surveillance.Furthermore, treatment planning may be influenced by the fluidity of the political impact on health care. 3rategies to mitigate the risk of potential teratogenic exposures could involve harmonization across EMR versions or health care systems, including linkage of EMR alerts and hard stops to use up-todate safety data to enhance clinician education and potentially reduce risk.Although such measures add to clinician burden, safeguarding fetal development is invaluable.Identifying opportunities where the EMR is uniquely equipped to enhance clinician education and improve outcomes warrants attention.

Table . Proportion of Women of Childbearing Years With an MCD
providing numeric results based on selected parameters.This cohort was divided into 3 different age groups: teenagers (12-17 years), adults (18-34 years), and women of advanced maternal age (35-50 years).No race or ethnicity data were used.An MCD included contraception as defined by EpicCare and procedures associated with sterilization.Abstinence, family planning, and sexual orientation were not listed as means of contraception in EpicCare.